mart-1-antigen and Margins-of-Excision

Staged excision has emerged as a superior treatment option for lentigo maligna (LM) of the head and neck when compared with conventional wide local excision. Assessing surgical excision margins for remaining LM poses a diagnostic challenge.. To determine whether immunohistochemical (IHC) staining with SOX10 and preferentially expressed antigen in melanoma (PRAME) aids in diagnosing LM on excision margins compared with conventional hematoxylin and eosin and Melan A IHC staining.. This study included cases of LM of the head and neck treated with staged excision. Histological findings were reviewed according to standard criteria for the diagnosis of LM and compared with the results after IHC staining for Melan A, SOX10, and PRAME.. The cohort consisted of 35 sections. Based on hematoxylin and eosin and Melan A IHC staining, 23 sections were diagnosed as LM by the initial pathologist. Further staining with SOX10 IHC showed only 8 to be consistent with a diagnosis of LM and 9 revealing features of actinic melanocyte hyperplasia. PRAME was positive in 5 of the 8 cases of LM and negative in all 9 cases of actinic melanocyte hyperplasia (P = 0.009). The presence of melanocyte nests (P = 0.29) and pagetoid spread (P = 0.003) was the most reliable histological findings distinguishing LM from its mimics.. SOX10 is a more specific and sensitive marker for melanocytes when assessing for LM on excision margins compared with Melan A. The addition of PRAME can be useful to confirm or exclude the diagnosis in challenging cases.

Topics: Antigens, Neoplasm; Eosine Yellowish-(YS); Hematoxylin; Humans; Hutchinson's Melanotic Freckle; Hyperplasia; Immunohistochemistry; Margins of Excision; MART-1 Antigen; Skin Neoplasms; SOXE Transcription Factors

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Immunohistochemistry; Male; Margins of Excision; MART-1 Antigen; Melanoma; Middle Aged; Mohs Surgery; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm, Residual; Retrospective Studies; Skin Neoplasms; Young Adult

Topics: Adult; Aged; Aged, 80 and over; Female; Head and Neck Neoplasms; Humans; Immunohistochemistry; Male; Margins of Excision; MART-1 Antigen; Melanoma; Middle Aged; Mohs Surgery; Neoplasm Invasiveness; Retrospective Studies; Skin Neoplasms; Surgical Wound; Time Factors; Travel; Wound Closure Techniques

Topics: Adult; Biomarkers, Tumor; Cross-Sectional Studies; Cytoreduction Surgical Procedures; Female; Humans; Immunohistochemistry; Male; Margins of Excision; MART-1 Antigen; Melanoma; Middle Aged; Mohs Surgery; Neoplasm Invasiveness; Neoplasm Staging; Practice Patterns, Physicians'; Skin; Skin Neoplasms; Surgeons; Surveys and Questionnaires

Topics: Adult; Aged; Aged, 80 and over; Eosine Yellowish-(YS); Female; Fluorescent Dyes; Frozen Sections; Hematoxylin; Humans; Male; Margins of Excision; MART-1 Antigen; Melanoma; Middle Aged; Mohs Surgery; Prospective Studies; Sensitivity and Specificity; Skin Neoplasms; Tissue Fixation

Perineural invasion, or neurotropism, is defined by the presence of cancer cells either within the neuronal sheath or found along the nerves. In melanoma, it is most commonly associated with invasive desmoplastic melanoma, a melanoma that is most commonly associated with malignant melanoma in situ, lentigo maligna type. Initially, perineural invasion was included in the reported Breslow thickness; however, recent data suggest that it should not be included. In this report, we describe a case of malignant melanoma in situ, lentigo maligna type, with associated neurotropism in the absence of invasive component.

Topics: Aged; Biopsy; Dermis; Follow-Up Studies; Humans; Hutchinson's Melanotic Freckle; Male; Margins of Excision; MART-1 Antigen; Melanoma; Neoplasm Invasiveness; Nerve Fibers; Scalp; SOXE Transcription Factors; Treatment Outcome

The increased use of Mohs micrographic surgery (MMS) to treat melanoma has been accompanied by wide variations in practice patterns and a lack of best practice guidelines.. The present study was a nationwide cross-sectional survey of Mohs surgeons to elucidate commonalities and variations in their use of MMS to treat melanoma.. A cross-sectional analysis was performed using survey responses of Mohs surgeons with membership in the American College of Mohs Surgery.. A total of 210/513 (40.9%) participants used MMS to treat melanoma of any subtype and 123/210 (58.6%) participants within this group treated invasive T1 melanoma (AJCC Eighth Edition) with MMS. A total of 172/210 (81.9%) participants debulked melanoma in situ (MIS). Average margin size of the first Mohs stage for MIS was 4.96 ± 1.74 mm. A total of 149/210 (71.0%) participants used immunohistochemical stains, with 145/149 (97.3%) using melanoma antigen recognized by T-cells 1 (MART-1) in 96.5% of melanoma cases treated with MMS.. Over half of surveyed Mohs surgeons treating melanoma with MMS are treating early invasive melanoma with MMS. Most Mohs surgeons treating melanoma with MMS debulk MIS and virtually all use MART-1 when excising invasive melanoma with MMS.

Topics: Adult; Cross-Sectional Studies; Cytoreduction Surgical Procedures; Female; Humans; Immunohistochemistry; Male; Margins of Excision; MART-1 Antigen; Melanoma; Middle Aged; Mohs Surgery; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Practice Guidelines as Topic; Practice Patterns, Physicians'; Skin; Skin Neoplasms; Surgeons; Treatment Outcome

Single-institution studies show that frozen section Mohs micrographic surgery (MMS) is an effective treatment modality for cutaneous melanoma, but no multi-institutional studies have been published.. To characterize the use of MMS in the treatment of melanoma at 3 academic and 8 private practices throughout the United States, to recommend excision margins when 100% histologic margin evaluation is not used, and to compare actual costs of tumor removal with MMS vs standard surgical excision.. Prospective, multicenter, cohort study of 562 melanomas treated with MMS with melanoma antigen recognized by T cells 1 immunostaining.. Primary trunk and extremity melanomas (noninvasive and invasive melanoma) achieved histologically negative margins in 97% of tumors with 10-mm margins, whereas 12-mm margins were necessary to achieve histologically negative margins in 97% of head and neck melanomas. Overall average cost per tumor treated was $1328.46.. Nonrandomized and noncontrolled study.. MMS with melanoma antigen recognized by T cells 1 immunostaining safely provides tissue conservation and same-day reconstruction of histologically verified tumor-free margins in a convenient, single-day procedure. When comprehensive margin evaluation is not used, initial surgical margins of at least 10 mm for primary trunk/extremity and 12 mm for head/neck melanomas should be used to achieve histologically negative margins 97% of the time.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Female; Hospital Costs; Humans; Male; Margins of Excision; MART-1 Antigen; Melanoma; Middle Aged; Mohs Surgery; Prospective Studies; Skin; Skin Neoplasms; Treatment Outcome; United States; Young Adult

Increased numbers of CD8

Topics: Adult; CD28 Antigens; CD8-Positive T-Lymphocytes; Complementarity Determining Regions; Cytotoxicity, Immunologic; Ear Neoplasms; Humans; Immunity, Cellular; Immunologic Memory; Male; Margins of Excision; MART-1 Antigen; Melanoma; Receptors, Antigen, T-Cell; Recurrence; Remission Induction; T-Cell Antigen Receptor Specificity